Scaling What Works to Improve the Use of Antipsychotics in Long-Term Care

A shared priority and a complex reality

Despite years of focused improvement efforts, the use of antipsychotics in long-term care continues to raise important questions about quality of life, safety and person-centred care. Today, approximately one in four residents in long-term care in Canada are prescribed antipsychotics without a diagnosis of psychosis. While these medications can be appropriate in certain situations, concerns remain when they are used without a clear clinical need or when the risks outweigh the benefits.

Targeted initiatives have led to measurable progress in appropriate use, but recent increases following the pandemic highlight how difficult it can be to sustain change over time without continued support.

Across this work, one aspect has become clear: improving how antipsychotics are used is closely tied to how care is understood and delivered.

Through its work with partners across the country, Healthcare Excellence Canada supports teams in applying the Appropriate Use of Antipsychotics (AUA) approach in practice. First developed in Manitoba, this evidence-informed, person-centred approach to AUA helps teams assess responsive behaviours, review medications and explore alternatives that better reflect each resident’s lived experience. In practice, it means looking beyond symptoms to understand what a person may be expressing and adjusting care accordingly.

Across Canada, Sparking Change in the Appropriate Use of Antipsychotics supported long-term care teams to apply this approach in their own settings.

Through the program, 86% of the homes that submitted the final Impact Award reduced their number of residents on antipsychotics without a diagnosis of psychosis, reaching nearly 900 residents. Of those targeted residents, 66% were able to safely stop (38%) or reduce (28%) their use of antipsychotics, and there was a 30% reduction in daily physical restraints.

These changes were also reflected in how teams approached care, including more frequent medication reviews, stronger engagement with families and greater use of non-pharmacological approaches.

Aligning with provincial efforts, homes in Manitoba successfully made progress towards AUA goals through participation in the program.

At East Gate Lodge Personal Care Home, nearly all targeted residents had their antipsychotic medications discontinued. Families described their loved ones as more alert, more interactive and more engaged in daily life.

At Riverview Health Centre, teams worked alongside residents and care partners to co-develop educational materials. This helped build a shared understanding of appropriate use and more informed decisions about deprescribing.

At Wawanesa Health Centre, daily routines were redesigned to better reflect residents’ lived experiences. Introducing outdoor, farm-like activities helped reduce responsive behaviours while improving overall well-being.

From progress to sustainability

The focus now is on sustaining this progress and spreading it more broadly, which depends on the right conditions being in place. Coaching, peer learning and practical tools help make these changes part of daily care, alongside the time and space needed to review medications, engage with families and test different approaches.

In Manitoba, this work is now being supported through the Manitoba Appropriate Use of Antipsychotics in Long-Term Care Collaborative, in partnership with Shared Health Manitoba. Building on what was established through Sparking Change, this provincial initiative offers structured support to strengthen person-centred practices and sustain improvements over time. It’s one of many initiatives contributing to Care Forward — a pan-Canadian movement to spread proven approaches further and improve care for more people across the country.

All Personal Care Homes in Manitoba are invited to register for the collaborative starting June 18, to prepare for this next phase of AUA support which will begin September 2026.